The role and nature of evidence: a systematic review of social workers' evidence-based practice orientation, attitudes, and implementation.

Journal of Evidence-Informed Social Work

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The Role and Nature of Evidence: A Systematic Review of Social Workers' Evidence-Based Practice Orientation, Attitudes, and Implementation Laura Scurlock-Evans & Dominic Upton To cite this article: Laura Scurlock-Evans & Dominic Upton (2015) The Role and Nature of Evidence: A Systematic Review of Social Workers' Evidence-Based Practice Orientation, Attitudes, and Implementation, Journal of Evidence-Informed Social Work, 12:4, 369-399, DOI: 10.1080/15433714.2013.853014 To link to this article: http://dx.doi.org/10.1080/15433714.2013.853014

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Date: 05 November 2015, At: 14:26

Journal of Evidence-Informed Social Work, 12:369–399, 2015 Copyright q Taylor & Francis Group, LLC ISSN: 2376-1407 print/2376-1415 online DOI: 10.1080/15433714.2013.853014

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The Role and Nature of Evidence: A Systematic Review of Social Workers’ Evidence-Based Practice Orientation, Attitudes, and Implementation Laura Scurlock-Evans Institute of Health and Society, University of Worcester, Henwick Grove, Worcester, United Kingdom

Dominic Upton Faculty of Health, University of Canberra, Canberra, Australia

Concerns have been raised over the appropriateness of adopting evidence-based practice (EBP) as a framework for practice within social work. In this systematic review the authors aim to synthesise research findings exploring social workers’ EBP orientation, attitudes, adoption, knowledge, skills, and perceived EBP barriers and facilitators. Numerous challenges to EBP implementation were identified, including: time management, research accessibility, and misperceptions of the role of evidence in decision making. Colleagues, supervisors, perceived experts, organizational culture, and tailored training were important for social workers’ dissemination and utilization of evidence. Social workers may prefer more conversational, face-to-face methods of research dissemination. Implications of the review findings are discussed. Keywords: Evidence-based practice, social workers, barriers, attitudes, knowledge

INTRODUCTION Although on the rise within social work, evidence-based practice (EBP) has not been embraced by all professionals in the field; concerns have been raised over whether its epistemological and ontological underpinnings are fundamentally at odds with those underpinning the social work profession, and whether EBP may constrain social workers’ practices (Bergmark & Lundstro¨m, 2011; Gray & McDonald, 2006). EBP originated in medicine and represents a process by which current best evidence, practitioner expertise, client and community preferences and values, and agency, societal, and political considerations are simultaneously blended, in order to provide clients with effective and contextualized services (McNeill, 2006; Regeher, Stern, & Shlonsky, 2007; Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). For the past 20–30 years EBP has been increasingly adopted in other areas of health and allied health (Upton, Scurlock-Evans, Stephens & Upton, 2012; Upton & Upton, 2006). Although coming later to social work, EBP has been suggested not only to be a philosophy of practice compatible with the profession’s codes and obligations, but also a means of preserving the integrity and philosophy Address correspondence to Laura Scurlock-Evans, Institute of Health and Society, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK. E-mail: [email protected]

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370

L. SCURLOCK-EVANS AND D. UPTON

of social work itself (Gossett & Weinman, 2007). In particular it has been identified as a means of ensuring ethical practice and accountability (Gray & McDonald, 2006). It has been suggested that some social work professionals’ concerns may arise from a misconception of the principles of this approach: Gambrill (2003) argues that descriptions of EBP in the social work literature are too narrow and down-play the original philosophy and process of EBP. Indeed, there are concerns that EBP is a prescriptive approach which has led to the development of such things as empirically supported treatment (EST) “lists,” which some feel are misleading and divert the role of EBP in the decision-making process (Thyer & Pignotti, 2011). Therefore, for some authors the current iteration of EBP in the social work literature should be a stepping-stone to developing a new approach of reflexive professionalism (Otto, Polutta, & Ziegler, 2009), which may help to avoid the perceived “conservatism” of EBP (Yunong & Fengzhi, 2009). According to Yunong and Fengzhi (2009), three preconditions must be fulfilled if EBP is to be adopted and implemented by social workers in their daily practice: (1) research evidence relevant to social work must exist, (2) social workers must have adequate resources and skills to be able to access and use this research, and (3), the benefits of utilizing EBP must equal or outweigh the costs of using EBP. There is therefore a need to explore the extent to which social workers perceive these preconditions as being met in current practice.

AIMS In this review the authors aim to synthesise research findings assessing social workers’ perceptions of, attitudes toward, adoption of, and knowledge and skills in implementing EBP. Furthermore, they seek to identify and synthesize the current barriers and enablers of EBP, and examine how these factors may be used to increase awareness, and quality and consistency of implementation of EBP within social work.

METHOD Design The authors followed the reporting standards identified by the PRISMA guidelines (Moher, Liberati, Tetzlaff, Altman & The PRISMA Group, 2009) for writing systematic reviews. A narrative synthesis framework (using text to summarize and explain research findings) was selected as it is suitably flexible to allow for the combination of diverse methodologies. Search Strategy Literature concerning social workers’ perception of EBP, and EBP practice, attitudes, and knowledge published between January 2003 and December 2012 was systematically searched. Academic Search Complete, Cumulative Index of Nursing and Allied Health Literature (CINAHL) Plus, American Psychological association databases (e.g., Psych info and Psych Articles), Medline, Journal Storage (JSTOR), and Science Direct, were searched using the combinations of free-text keywords and MeSH (or equivalent) terms. Terms used included: “Social Work,” “Evidence-Based Practice,” “Perceptions,” “Barriers,” “Attitudes,” “Implementation,” “Use,” “Knowledge,” “role and nature of evidence,” “Evidence-Informed Practice,” (MM “Evidence-Based Practice”), (DE “EVIDENCE-based social work”), (MM “Social Work”). Reference lists of suitable articles were also searched to identify additional studies. An example search strategy is available from the corresponding author upon request.

SOCIAL WORKERS’ EVIDENCE-BASED PRACTICE: A REVIEW

371

Search Outcome Each article was initially reviewed according to the following inclusion criteria: . Published in a peer-reviewed journal in English language; . Published between January 2003 and December 2012 (to allow for broad coverage and

currency);

. Provided sufficiently detailed, extractable results for qualified social work professionals if

more than one professional group’s results reported;


. Focused on at least one of the following:

-

Social Social Social Social Social

Workers’ Workers’ Workers’ Workers’ Workers’

perceptions of evidence, EBP or evidence-informed practice; knowledge or understanding of EBP; attitudes toward EBP; implementation of EBP; perceptions of the barriers (and facilitators) of EBP.

To ensure comparisons across studies and findings were meaningful, only research from the following Western cultural regions were included: UK & Ireland, Europe, Northern America (US & Canada), Australia, and New Zealand. In total, 32 articles were retrieved meeting the above criteria; 18 used a quantitative method, 7 qualitative, and 7 mixed-methods designs. A flow chart of study retrieval and selection is presented in Figure 1. The results of two articles (Arnd-Caddigan, 2012; Arnd-Caddigan & Pozzuto, 2010) were combined as they represented the same study (N ¼ 31). Quality Appraisal Each article underwent quality appraisal. Quantitative articles were appraised using a tool developed by the Effective Public Health Practice Project (EPHPP: Thomas, Ciliska, Dobbins, & Micucci, 2004). Each study was rated as strong, moderate, or weak (scores presented in Table 1). Qualitative articles were appraised using the consolidated criteria for reporting qualitative research (COREQ) developed by Tong, Sainsbury, and Craig (2007). The tool was modified in order to rate the articles as strong, moderate, or weak. Mixed-methods research was evaluated using both tools in combination. Articles were appraised by both authors and disagreements resolved by consensus.

RESULTS Despite known variations between countries’ social work provision, a number of key themes were evident across the literature. The prominence of these themes suggests they are pervasive and represent factors common to the practice of social workers across contexts. As there were no obvious systematic differences in the characteristics (e.g., methodology or findings) of the research across regions or publication date, it was decided that the results would be most meaningfully structured around these themes. However, to aid with interpretation of the findings studies’ characteristics and findings are presented by region and date in supplementary information Table 1. The Meaning of EBP Despite many social workers having heard of EBP (Booth, Booth, & Falzon, 2003), there is still much confusion regarding what it actually is (Murphy & McDonald, 2004). Social workers attribute


Records identified through database searching (n = 2273)

Additional records identified through other sources (n = 29)

Screening

Records after removal of duplicates (n = 1864)

Records screened (n = 1864)

Eligibility

Full text articles assessed for eligibility (n = 60)

Records excluded (n = 1803)

Full text articles excluded based on inclusion criteria (n = 28) • Not research—6 excluded • No focus on primary inclusion criteria (i.e., EBP attitudes, knowledge)—10 excluded • Not qualified social workers (i.e., student social workers)—10 excluded • Results for qualified social workers not extractable—2 excluded

Included


Identification

372

Quantitative studies included (n = 18)

Qualitative studies included (n = 6)

Mixed-methods studies included (n = 7)

FIGURE 1 Flow chart of the study retrieval and selection process.

a range or meanings, both positive and negative, to EBP. For example, in a sample of Swedish social workers, Bergmark and Lundstro¨m (2011) found the majority of their participants felt they understood the meaning of EBP and associated it with a variety of practices which could be used to inform decision making. However, a substantial minority considered EBP to be a prescriptive practice, based on specific EBP manuals and guidelines. Indeed, while some social workers felt EBP could provide a means of enhancing the professionalism of the sector, and reduce time, effort, and financial waste (Bellamy, Bledsoe, & Traube, 2006; Booth et al., 2003), others felt it reduced professional discretion (Bergmark & Lundstro¨m, 2011; Gray & McDonald, 2006) and lead to the exclusion of clients from potentially useful services (Arnd-Caddigan & Pozzuto, 2010) owing to its deterministic nature and over-reliance on positivism. This has led some social workers to feel that is better suited to medical professions rather than social work (Bergmark & Lundstro¨m, 2011; Murphy & McDonald, 2004). In short, EBP is viewed by some social workers as relying on a too narrow definition of evidence, representing a scientific approach to non-scientific problems (Murphy & McDonald, 2004). The reasons for this split in views over EBP is not clear, but may result from a lack of common language across professionals, contexts, and approaches to define practice (Murphy & McDonald, 2004). Some authors felt that EBP would be a useful framework for social work if understood as a broad conceptualization that embraced multiple forms of knowledge (Fielding, Crawford, Leitmann & Anderson, 2009; Murphy & McDonald, 2004; Wharton & Bolland, 2012), and recognized the different world views and personalities of social workers (Arnd-Caddigan, 2012;

Sample

Reference

Design

Descriptive survey, containing 14 value-oriented statements.

Design

Social Work Professionals (N ¼ 155) A cross-sectional survey, devised from Social Care and Social Work by the author. agencies within the UK. Response rate was 43.4%.

Random sample of Swedish social workers and middle managers (n ¼ 889) within the Swedish municipal social services (response rate ¼ 71%).

Bergmark & Lundstro¨m, 2011.

Morago, 2010

Sample

Reference

†

To examine levels of EBP † dissemination and implementation by social workers in social work † agencies within the UK. †

Purpose

UK Research

†

†

†

Explore Swedish social worker’s † views on, attitudes toward and use of EBP. †

Purpose

European Research

62% of participants reported never attending training. 74.8% report having a good knowledge of EBP. 128 respondents reported either ‘very poor’ or ‘modest’ implementation of EBP. The main barriers being lack of time (80%), lack of training (71%), lack of leadership (47.7%) and lack of organisational support (46.5%).

Findings

† †

†

†

Majority of participants understood † the meaning of EBP; Substantial minority of social workers understood EBP to involve working in a pre-described manner. Although the majority of participants † held positive views of EBP, a minority held negative. Participants with greater awareness of research and higher academic qualifications were more likely to have positive attitudes toward EBP. Revealed a “small but important EBP “resistance movement”.

Findings

TABLE 1 Summary of Characteristics and Findings of Studies, Arranged According To Region

Quality Score

Incomplete sampling frame used. Social desirability effects possible. Potential for selection bias. Low response rate.

Study limitations

(Continued)

Weak

Quality Score

No comparison of responder’s Strong and non-responders characteristics (although there is a relatively high response rate). Further exploration of social workers’ understanding of the meaning of EBP may help to clarify other findings of the survey.

Study limitations



373

Anonymous postal questionnaire.

Random sample of recent graduates from 3 London Universities; Social workers (N ¼ 26), Occupational Therapists (N ¼ 29), Physiotherapists (N ¼ 10), and Nurses (N ¼ 1). Overall response rate was 43%.

Caldwell et al. 2007

Design

Opportunistic sample of 368 social Cross-sectional survey via e-mail. workers (response rate ¼ 24%) from a social care workforce from two UK councils with social service responsibilities.

Sample

Cooke, Bacigalupo, Halladay, & Norwood, 2008.

Reference

†

Explore relevance of initial † professional training in relation to EBP and explore practitioners’ confidence in engaging with EBP. †

†

†

†

To explore the level of research † activity, use, interests, and skill of social care staff from two UK councils. †

Purpose

UK Research

TABLE 1 – continued

Most participants (69%) had access to the internet; 65% of these individuals reported using it for work. Although 42% of individuals had access to senior practitioners who provided them with research information, under half actually consulted them to obtain such information. 12.8% of individuals had access to literature databases; over 50% of these used them. Most common barriers: work pressures, lack of expertise, research not a priority in the workplace, staff shortages, inflexible working patterns and lack of funding/resources. Protected time for research, mentorship and apprenticeships were identified as possible ways of enabling research use/activity. Majority of practitioners stated they had received training in conducting literature searches. Practitioners held positive attitudes towards EBP and research evidence; however, implementation of EBP by practitioners is infrequent with limited utilisation of research resources. Despite the majority of respondents agreeing that EBP is favoured among colleagues, many agreed that there was a lack of time in implementing EBP.

Findings

† † †

†

†

† Weak

Quality Score

(Continued)

Sampling bias. Weak Low response rate. Potential for social desirability effects.

Low response rate (although large sample size achieved). Potential bias—administered via e-mail—individuals less confident with technology may not therefore have accessed the survey (possibly skewing the results). No data on non-responders’ characteristics.

Study limitations


374 L. SCURLOCK-EVANS AND D. UPTON

Sample

28 social workers from the Southern Health and Social Services Board (SH&SSB) in Northern Ireland.

Purposive sample of 29 social care staff from four social services departments in England (response rate not provided).

Reference

Wilson & Douglas, 2007.

Hagell & Spencer, 2004.

Mixed methods exploratory evaluation, involving a preintervention questionnaire (n ¼ 29), focus groups (n ¼ 25) and individual questioning post intervention (n ¼ 20).

Mixed-methods evaluation involving questionnaires and qualitative feedback in the plenary session of the workshop.

Design

†

To explore the impact of a method † of keeping social care staff up to date with research findings, using audiotapes.

†

†

†

†

To evaluate the impact of a † workshop designed to disseminate local examples of evidence-based † practice produced by staff within the SH&SSB. †

Purpose

UK Research


Vast majority of participants felt EBP was important/very important. Mixed results were obtained for participants’ satisfaction in their EBP knowledge. Only 8 participants used EBP in their work often, 13 sometimes, 7 seldom and 1 never. 19 participants had access to the internet and library, 30 had access to relevant journals/publications, 7 had access to forums for the sharing of case material and only one was able to attend multi-disciplinary case discussion. 9 participants were satisfied/ very satisfied with level of EBP support from their line manager. Barriers to EBP: lack of time (most significant barrier), lack of information, knowledge and training and lack of organisational focus on EBP. Having more time to study literature, providing workload easement, and protected time and forums for discussion were identified as potential enablers of EBP. Knowledge of the research area prior to the intervention was explored through a factual questionnaire (not received well by the participants and subsequently dropped from remainder of the study). The lowest number of correct responses was 44% and the highest was 83%. Listening to the tapes took up “dead time” (e.g., driving), but some information was difficult to absorb in this format. This indicates that this medium is better suited to some forms of information than others.

Findings

†

†

† †

†

Quality Score

Small number of social services departments used as initial sampling frame— implications for representativeness of sample. No methods of triangulation/ participant checking detailed.

(Continued)

Quantitative: Weak Qualitative: Weak

Only staff from a single social Weak services agency. Small sample size. Questionnaire administered immediately after the workshop.

Study limitations



375

Social services employees within Trent region of England. 161 respondents for questionnaire. Response rate was 27%.

Child and family social carer; Agency representatives (N ¼ 40), Agency managers (N ¼ 36) and staff members (N ¼ 40).

Barratt, 2003

Sample

Booth, Booth, & Falzon, 2003

Reference

Mixed method Research in Practice project; Discussion groups (N ¼ 40), semi-structured telephone interviews (N ¼ 36) and questionnaire (N ¼ 40).

Mixed-Method design; Postal survey with 27 individual semistructured interviews

Design

†

†

†

†

Northern American Research

Aimed to consider EBP and how it † is supported within child and family social care, and to build upon professionals’ knowledge involved in these services.

To explore the literature concerning research evidence and social workers within the Trent region attitudes towards EBP.

Purpose

UK Research


†

†

†

†

†

†

† There was a pronounced uncertainty about the nature of EBP; discussion groups saw expert opinions as a type of evidence with 61% of survey † respondents agreeing that expert opinion influences practice decisions. Respondents suggested a need for internet access (82%) and access to library sources (80%) in order to promote EBP implementation. Two barriers were perceived towards adoption of EBP; Social care being dominated by “blaming culture,” with social workers fearing that they may “get it wrong,” hence relying on previous methods, and a lack of professional development and training associated with EBP.

Conversational and upbeat styles of delivery felt to be more effective by participants than “academic lecturing styles.” Social care staff used a range of different sources of information 44% of respondents had received training in “using research findings” while 42% received training in ‘using the Internet’. 72% of respondents had heard of “evidence-based social care.” The majority of interviewees held positive views towards EBP, hoping that it would reduce money, time and effort waste. Some also felt that the EBP model would add to the professionalism of the sector. In order for EBP to be successful, interviewees suggested that workloads, lack of accessibility to relevant information and time allocated for research were the largest barriers.

Findings

No analysis of nonresponder’s characteristics reported. Small sample size for questionnaire.

Potential over-representation of managers. No details of triangulation/ participant checking procedures. Reliability/validity of questionnaire used not described sufficiently. Potential for social desirability effects. Low response rate for questionnaire.

Reliability/validity of questionnaire not described sufficiently.

Study limitations


(Continued)

Quantitative: Weak Qualitative: Weak.

Quantitative: Moderate Qualitative: Weak

Quality Score


Opportunistic sample of 140 case managers from the Oklahoma Children’s Services System.

Purposive and convenience sampling of three clinical social workers serving Medicaid recipients in the US. Participants were selected through approaching social workers and asking them to propose social workers whom they viewed to be “successful” practitioners.

A sample of US social workers (n ¼ 285) and non-social workers (n ¼ 855) working in the field of substance use disorder treatment.

ArndCaddigan, 2012.

Bride, Kintzle, Abraham, & Roman, 2012.

Sample

Aarons & Sommerfeld, 2012

Reference

Purpose

1140 SUD counsellors (social workers and non-social workers) completed a postal questionnaire (response rate ¼ 58.0%)

†

†

†

†

To explore the perceptions and use † of two evidence-based practices (motivational interviewing and contingency management). †

Qualitative research recognizing To explore how clinicians have the researcher’s role in the dialogic responded to a policy designed to process and using thematic mandate a form of EBP. analysis. Participants were presented with a simulated client (trained by the researcher) and asked to treat them. Participants also completed assessment and treatment plans and were interviewed (unstructured) by the researchers.

Usual (SAU; n ¼ 55) group.

Data collected as part of a To examine the differential roles † longitudinal mixed-methods study of transformational leadership and of a state-wide EBP leader-member exchange, on team † implementation (EBPI). innovation climate and attitudes toward EBP adoption, during a Random assignment of teams at regional level, to a treatment group state-wide EBPI of an intervention (SafeCare; n ¼ 85) vs. Service As to reduce child neglect (SafeCare). †

Design



Transformational leadership predicted higher innovation climate for the SAU group. Innovation climate associated with more positive attitudes toward EBP for the EBPI group. Strategies to enhance supervisor transformational leadership may provide a means of enhancing the climate of EBPI and instil more positive attitudes toward EBP. Although clinicians reported their work as consistent with the policy and demonstrated elements of EBP, their actual practice was not fully in line with EBP. The researcher identified values which were fully in line with social work, but conflicted with EBP (e.g., research exploring the therapeutic alliance rather than outcome research only), which affected participants’ attitudes and behaviour toward the policy. Clinicians highlighted the importance of their worldview in their practice. Clinicians reported their practices in different ways depending upon context (i.e., for the research vs. insurance purposes). Exposure to EBP is crucial to the development of positive attitudes toward EBP. Professional networks and training are an important means of introducing EBP.

Findings

†

†

†

†

†

Quality Score

Moderate

(Continued)

Incentive payments of $40 per Moderate participant completing the survey were provided. Non-responders’ characteristics were not analysed.

Sampling method may introduce bias into the research findings.

Unbalanced groups (more in the Moderate treatment than control group). Relatively small sample sizes. Self-report data, rather than objective measures used.

Study limitations



377

Parrish & Rubin, 2012.

Reference

Design

Random sample of (n ¼ 688, Online and postal cross-sectional response rate ¼ 21%) NASW survey. members in Texas, and Licensed Marriage and Family Therapists (LMFTs; n ¼ 69, response rate ¼ 33%) and Psychologists (n ¼ 108, response rate ¼ 40%) from state licensing lists.

Sample

†

†

†

†

†

†

To explore the differences † between social workers, LMFTs and psychologists on their orientation toward and use of EBP.

Purpose



Social workers were more likely to use motivational interviewing and contingency management if colleagues used them and if they had received specific training on them. Overall, lower scores on ratings of perceived effectiveness of MI was associated with longer work experience in the field. Whereas holding a graduate degree was significantly associated with higher ratings of perceived effectiveness. Significant differences between the † three professions; social workers reporting higher levels of more females and greater number of previous courses. 27.8% of social workers reported † using research evidence/practice guidelines often or very often, 15% reported implementing all EBP steps often or very often 49% reported evaluating the outcomes of their practice often or very often. Social workers appeared to have more positive attitudes toward EBP than LMFTs, but this was explained by confounding variables (e.g., length of practice). More recent social work graduates displayed more positive attitudes toward EBP and had greater overall orientations toward EBP than earlier graduates. No significant differences between recent and earlier graduates on level of EBP self-efficacy, perceived feasibility or implementation of EBP.

Findings

Differences in methods (i.e., electronic vs. postal survey) between the professional groups may have introduced bias to the findings. Relatively low response rates for some professions.

Study limitations


(Continued)

Weak

Quality Score


Sample

A random sample of 400 LCSWs (response rate ¼ 45%) from across the united states. Part of the sample comprised individuals who had taken part in the survey reported in Pignotti & Thyer (2009).

A random sample of 159 NASW social workers in the US (response rate not reported).

Reference

Pignotti & Thyer, 2012

Wharton & Bolland, 2012.

Online cross-sectional survey (specifically designed for the study).

An electronic survey comprising demographic questions, commonly used interventions, and use of Novel Unsupported Therapies (NUSTs), Conventional Unsupported Therapies (CNUSTs) and Empirically Supported Therapies (ESTs).

Design

To explore social worker practitioners’ perspective on and implementation of EBP.

†

†

†

†

†

To explore the interventions † mostly used by LCSW and whether there is any association between use of novel unsupported therapies (NUTs) and practitioner demographics and attitudes toward EBP. †

Purpose



97% of participants reported using at least one EST, but 75.2% reported having used at least one NUST, and 86% reported having used at least one NUST or CUST within the past 12 months. Overall, the most popular reasons for selecting interventions were clinical experience with positive results held up over time, compatibility with theoretical orientation and compatibility with therapist’s personality. Peer reviewed research featured lower as a reason for selecting an intervention. Different theoretical orientations were associated with different reasons for selecting interventions (i.e., CBT was associated with higher ratings for peer reviewed evidence than non-CBT orientations). Social workers were more likely to consult with peers, supervisors or experts than research before making practice decisions, and use a comparative and intuitive approach rather than an empirical approach to evaluating research. The utility of research evidence was determined through their own practice wisdom. The majority of participants had access to the Internet, research databases and journals at work. However only a small number had dedicated EBP work policies.

Findings

† †

†

†

Sample may not be representative of the wider social worker population. Small sample size. No comparison of responders vs. non-responders.

Only individuals with internet access recruited.

Study limitations


(Continued)

Weak

Moderate

Quality Score


379

Sample

Design

A convenience sample of 69 community social work practitioners who had taken part in a training event.

Parrish & Rubin, 2011.

Replicated one-group pre-test post-test design with a 3 month follow-up, using the EBPAS measure.

Social Work Practitioners (N ¼ 200) A cross-sectional survey within the United States and the UK. including; a demographic information questionnaire and the SWEBP Scale.

Pope, Rollins, Chumba, & Risler, 2011

Krantz, 2011. Systematic random sample of 216 Cross-sectional postal survey. (response rate ¼ 66%) Rhode Island clinical social worker members of the National Association of Social Workers (NASW).

Reference

To evaluate the impact of a oneday continuing education training on the EBP process with community practitioners.

To explore the perceptions, knowledge and utilisation of EBP in a sample of social work practitioners across different practice settings.

To explore the nature of social workers’ practice, and their skills and levels of confidence in their practice.

Purpose



†

†

†

†

†

†

†

Participants’ EBP self-efficacy, attitudes, feasibility, intentions, and knowledge all improved significantly following the intervention at the 3 month follow-up.

†

† †

The majority of respondents had time during their work to access and read literature, but that time-management was a barrier to EBP. Further barriers included: access and cost, lack of knowledge and the perceived “overwhelmingness” of the research. The profile of skills used by social † workers could be grouped into Counselling/problem-solving, † insight-oriented and case management/referral skills. Social workers were high in selfefficacy for practising individual therapy with substance abuse clients and ethics. They reported moderate self-efficacy in case management, assessment and group therapy. Social workers were influenced by outcome research to guide practice, and used problem-solving and insightoriented skills in their work with clients. Appeared to be general endorsement of evidence-based practices. Although 83% of respondents agreed † that they were familiar with social work databases, only 56% agreed that they used relevant research within their practice. However, 87% agreed that they incorporate clinical judgement and social work research within their practice.

Findings

No control group. Potential for the presence of social desirability effects. Convenience sample used.

Potential for selection bias (reliance on access to technology).

No comparison of responders vs. non-responders. Some important confounding variables potentially overlooked (e.g. organisational culture and access to research).

Study limitations


(Continued)

Strong

Weak

Moderate

Quality Score


Sample

Purposive sampling of three clinical social workers serving Medicaid recipients in the US. Participants were selected through approaching social workers and asking them to propose social workers whom they viewed to be “successful” practitioners.

250 school social workers (members of the School Social Work Association of America) from 31 states in the US (response rate not possible to calculate).

Reference

ArndCaddigan, & Pozzuto, 2010.

Cawood, 2010

Cross-sectional, web-based survey.

Qualitative research recognising the researcher’s role in the dialogic process and using thematic analysis. Participants were presented with a simulated client (trained by the researcher) and asked to treat them. Participants also completed assessment and treatment plans and were interviewed (unstructured) by the researchers.

Design

†

†

†

†

†

To explore barriers to † implementing violence prevention/intervention sessions in US schools.

To explore how a policy mandating EBP for Medicaid supported clients effects the provision of services in social work.

Purpose



A one-day training course may be an effective means of developing EBP in social work practice. Clinicians’ responses suggested that many clients were potentially being excluded from services which could be of benefit for them, owing to the mandate. The participants discussed how they must use terminology and describe assessments/treatments in language that companies responsible for payment for the services will not question. Although clinicians felt that they were only presenting their practice in a manner which companies find useful, it appeared that this prevented the full picture of the nature of therapy from being provided. The two greatest barriers identified by social workers were the strong academic focus (i.e., focus almost exclusively on students’ academic improvement, rather than violence prevention/intervention and lack of time). Other barriers included: competing demands, lack of training, lack of resources for purchasing instructional materials, lack of knowledge of programmes and curriculum, and lack of support (at district or principal level) to implement strategies. The four greatest enables that would help social workers to address violence more effectively were: more time, more resources, materials and curriculum, increase in staffing and more training.

Findings

† † †

†

Moderate

Quality Score

(Continued)

Convenience sample. Weak No inferential statistics. Difficult to assess how survey was administered and therefore how representative the sample is of social workers of all school social workers in the US.

Sampling method may introduce bias into the research findings.

Study limitations



381

Opportunistic sample of 1261 (response rate ¼ 56.3%) employees of the public child welfare agency of a Midwestern state. Only 900 participants’ data was used as this represented all respondents working in frontline services.

Convenience sample of 16 individuals from three US social work agencies (response rate not reported) in a range of roles.

Manuel, Mullen, Fang, Bellamy, & Bledsoe, 2009.

Sample

CollinsCamargo, & Royse, 2010.

Reference

Process and outcome evaluation, using case analysis. Primary data collection involved focus groups with the participants at each agency before and after an intervention. Data was triangulated from a range of sources and analysed using thematic analysis.

Secondary analysis of data collected via a cross-sectional, electronic survey, administered via email. Data was collected in 2003. Questionnaire comprised the Survey of Organizational Excellence (SOE) and the SelfEfficacy Assessment-Social Work (SEA-SW) Scale (Ellet, 2001).

Design

†

†

To explore the practitioners’ views † of EBP, following participation in an intervention aimed at † supporting EBP in social work. The “Bringing Evidence for Social Work Training” (BEST) project involved training and technical assistance from university researchers and the three social work agencies.

†

To explore the relationship † between social workers’ perception of effective supervision and worker competency in child welfare practice. †

Purpose



Differences identified for inexperienced workers’ self-efficacy based on ratings of supervision effectiveness received. Respondents receiving effective supervisions were more likely to perceive their organisational culture as promoting EBP. Significant difference in self-efficacy based on perception of organisational culture. Practitioners were able to learn EBP processes and developed positive attitudes toward EBP. Barriers to EBP implementation identified at individual, organisational and system levels. +Individual level barriers: suspicion of research and lack of knowledge, skills, training, supervision and monitoring pertaining to research. +Organisational level barriers: agency characteristics and lack of needed resources. +Systematic barrier: lack of fit or applicability of research findings to specific practice contexts. Promoters to EBP barriers: a team approach to EBP implementation, further training to enhance research appraisal skills and greater partnership working with universities. Methods for disseminating and implementing EBP do not take into account real-world.

Findings

†

†

†

†

Quality Score

Small sample size.

(Continued)

Weak

Selection bias (technology Moderate required to participate). Potential evidence of socially desirable responding. Issues with inferring causality, as based on self-report crosssectional data.

Study limitations



Sample

193 Licenced Clinical Social Workers (LCSW) within America. Response rate was 52%.

Stage 1: 17 agencies involved in a family support project in California. Stage 2: community social workers (n ¼ 245, response rate not reported) involved in the agencies in stage 1.

Reference

Pignotti & Thyer, 2009

Carrilio, 2008.

Multi-stage evaluation. Stage 1: complex investigation of 17 agencies Stage 2: cross-sectional postal survey of community social workers.

A survey instrument (EBP scale; EBPAS) developed by Survey Monkey and administered by Internet; postal invitations were also sent.

Design

†

†

†

Job role, skill and experience with † using computers and attitudes toward † data were significantly associated with information system use. Perceived usefulness of the data and ease of use were also significantly correlated. 20% of the practitioners responding to the survey did not feel comfortable using computers. Approximately 20% of practitioners consistently reported negative attitudes toward evaluating practice and using data. Overall, worker attitudes appear less important than skill and experience in determining information system use.

†

To investigate the organisational and worker characteristics associated with the use of information systems.

A large proportion of social workers † reported having used at least one NUT within the last year (75.9%) with † 86.5% reporting use of more conventional widely used unsupported therapies (CNUTs). Mean scores for the entire sample of social workers on the EBPAS were 53.7 suggesting an overall positive attitude towards EBP. Also a large majority of respondents reported using an evidence-based therapy in their top three most frequently used.

Findings

To explore the interventions † mostly used by LCSW and whether there is any association between use of novel unsupported therapies (NUTs) and practitioner demographics and attitudes toward EBP. †

Purpose



Quality Score

No response rate reported. Representativeness of the sample is unclear.

(Continued)

Weak

Only individuals with Internet Moderate access recruited. Sample may not be representative of the wider social worker population.

Study limitations



383

The entire sampling frame of social Descriptive postal survey. work field instructors from 418 local, national and international agencies in the US were initially invited to participate. As a results, 283 field instructors within 180 agencies responded (response rate ¼ 47%).

Edmond, Megivern, Williams, Rochman, & Howard, 2006. To explore social work field instructor’s views and use of evidence-based practice.

To explore the strategies, challenges and observations of experts concerning the implementation of EBP.

†

†

†

†

†

†

†

Experts noted that EBP was disseminated in various areas within social care. Although, it was said that there was a lack of actual implementation. Training time and funding polices were the most significant barrier towards EBP. Experts agreed that the use of unsupported interventions could prove detrimental or harmful. They believed that the lack of EBP would support the view of social work being a second-class citizen when compared with the other professions. The majority of participants (87%) agreed/strongly agreed EBP is a useful practice idea. Most frequently employed EBP step was “formulating specific answerable questions regarding practice information needed”. 70% of respondents felt supported by their employer. Only 52% of participants felt their colleagues always or usually used scientifically supported or tested interventions. Most accessible information resources: internet (96%), professional journals (79%) and practice manuals (67%)

Experts in mental health services and Semi-structured interviews. evidence-based clinical interventions in social work (N ¼ 8).

Bellamy, Bledsoe, & Traube, 2006.

†

Findings Six factors were apparent as critical for EBP implementation: (1) Acceptability of EBP to the family and caseworker, (2) Motivation for using EBP, (3) Suitability of EBP in meeting the family’s needs, (4) training experiences in EBP, (5) Organizational support for EBP, and (6) The impact of EBP on both the process and outcome.

Purpose

Semi-structured interviews lasting To examine social care providers † 1 hour. perspectives concerning the implementation of EBP and to understand which factors could be modified in order to facilitate EBP.

Design

Child welfare case managers (N ¼ 15) and consultants (N ¼ 2) involved in the implementation of SafeCare.

Sample

Aarons & Palinkas, 2007.

Reference



† † †

†

†

†

†

Potential selection bias. Low response rate. Social desirability effects possible.

Small sample size.

Selection bias potentially present. Methods of triangulation/ participant checking not sufficiently described. No discussion of data saturation.

Study limitations


(Continued)

Weak

Strong

Moderate

Quality Score


Kreuger, Stretch, & Kelly, 2006.

Reference

Design

Random sample of 200 alumni of a Cross-sectional postal survey. Midwestern university who had graduated with a Masters in Social Work and were working in a range of settings.

Sample

To explore the impact of technology on EBP practice.

Purpose



†

†

†

†

†

†

† 97% relied on practice experience, 71% intuition, 71% practice guidelines, 60% advice from colleagues, 56% empirically tested interventions, 38% systematic reviews and 16% manualized therapies in practice decisions. 84% of participants reported lack of time as the major barrier to EBP implementation, 36% reported lack of information in the literature 22% felt computer skills held them back. Most respondents reported daily use of microcomputers (73%), with approximately 44% of respondents reporting using home PCs each day. 74% of respondents felt the introduction of new technology resulted in greater control over their work tasks, but 20% felt they had less or no control over their work. Only 34% of respondents reported receiving in house training in various aspects of technology. 28% of respondents felt technology had reduced their personal discretion, with a further 62% feeling that it may have reduced their discretion. Concerns that new technologies may encourage “fast practice” which directs efforts away from sound practice toward object-oriented narratives.

Findings

†

†

†

†

Quality Score

(Continued)

No comparison of responders Weak vs. non responders. Focus on microcomputers (largely replaced by PCs) may be misleading. Respondents were all graduates from the same university. Only descriptive statistics reported.

Study limitations



385

Sample

Social workers, professional leaders and managers (N ¼ 40) from New Zealand.

Beddoe, 2011.

Mental health social carers within San Diego County (N ¼ 322) and Programme managers (N ¼ 51).

Sample

Reference

Aarons, 2004

Reference

Semi-structured interviews (N ¼ 17) and focus groups (N ¼ 6)

Design

Aimed to develop a measure of attitudes towards EBP and, secondly, to determine service providers attitudes towards EBP.

Purpose †

Examine the views of social workers within New Zealand on the importance of on-going education and research as part of professional education and development.

Purpose

†

†

†

Findings

Social workers agreed on the † importance of research and being well informed but acknowledged a lack of practice ethics within such research. † The social workers suggested that † managers can place significant focus on service delivery while ignoring research activities. The interviewees were all aware of EBP but showed some uncertainty towards how social workers could be involved with it. Some highlighted issues with EBP and its conflict with person-centeredness and social enquiry, suggesting that the literature does not flow with practice. Practitioners also agreed that there were significant time constraints.

Findings

The EBPAS demonstrated good † internal consistency reliability. It was discovered that interns held more positive attitudes towards EBP when † compared with professional providers. Educational attainment was also associated with positive attitudes towards EBP implementation.

Australian and New Zealandian Research

Mixed method design; Selfadministered survey (EBPAS) and 51 individual semi-structured interviews.

Design



Imbalance between numbers of male and female participants. Potential for selection bias. Authors recognise the potential impact of the researcher on the findings.

Study limitations

Social desirability effects may be present.

No exploration of nonresponders’ characteristics

Study limitations


(Continued)

Weak

Quality Score

Moderate

Quality Score


Random sample from 65 hospitals in A 25-item, closed questionnaire New South Wales (Australia); Social survey was distributed. Workers (N ¼ 146), Physiotherapists (N ¼ 228), Occupational therapists (N ¼ 118), Pharmacy (N ¼ 84), Clinical psychology (N ¼ 59) Dietetics (N ¼ 78), Speech Pathology (N ¼ 77).

Convenience sample of 207 health Mixed-methods research using practitioners (response rate ¼ 62%), questionnaires and interviews of which 9 (response rate of 53%) (analysed using thematic analysis). were social workers, took part in the survey portion of the study. 50 (no response rate) practitioners, of which 6 were social workers, took part in individual interviews.

Gosling & Westbrook, 2004.

Murphy & McDonald, 2004.

Semi-structured interviews with social workers about their practice, in a case study of their own choosing. Data was analysed thematically.

Purposive sample of four social workers in health settings identified as effective by their managers from West Australia.

Fielding, Crawford, Leitmann, & Anderson, 2009.

Design

Sample

Reference

†

†

†

†

†

To explore the perceived usefulness of EBP and the implications for the professional status of rural social workers in Victoria.

†

†

†

Explored practitioners’ awareness † of a evidence resource online system and their utilization of evidence and the system. Considered practitioners perceived † barriers toward utilization of evidence system within clinical practice. †

To explore how “effective” and experienced practitioners use knowledge and evidence in their practice.

Purpose

American Research


Only themes from two of the practitioners are reported in this paper. Both participants felt the interview was important for reflecting on their practice. Social workers should be viewed as active agents in EBP, who leave traces of their EBP practice at their worksites and are therefore important in the process of generating new knowledge. A reflective space is important to enhance reflective practice. There is a need to broaden the current conceptualisation of EBP, to include multiple forms of knowledge claims. The majority of practitioners (59%) were aware of the online evidence system, but only 55% of these individuals used it. The dominant factors associated with utilisation were accessibility, computer skills, and perceived support. Main barrier toward utilization of the system was lack of training associated with its use. Social workers rated their knowledge of evidence lowest compared with the other disciplines. Majority of social workers not clear on the definition of EBP. Rural practitioners identified decreased professional development (partly owing to poorer IT infrastructures and difficulties in accessing training).

Findings

†

†

†

†

†

Small sample sizes for the questionnaire data for social workers. No comparison of responders and non-responders.

No exploration of nonresponders’ characteristics. Social desirability effects potentially present.

Sampling methods may have introduced bias into the research findings.

Study limitations


(Continued)

Weak

Weak

Weak

Quality Score


387

Reference

Sample

Design

Purpose

American Research


†

†

†

†

† Usage of research evidence diminished as “rurality” increased. EBP was felt to be better suited to other, more medical professions. Social workers suggested that EBP was missing from their initial formal training and from on-going professional development. EBP was viewed as a scientific approach to non-scientific issues and therefore fundamentally incompatible. Social workers suggested that EBP is appropriate, but that relying on “scientific outcomes,” rather than a variety of knowledge and information, was the issue.

Findings

Study limitations


Quality Score



389

Parrish & Rubin, 2012). Individuals who held less positive attitudes toward EBP were concerned that it was in conflict with person-centeredness and social enquiry (Beddoe, 2011). The more negative meanings associated with EBP may also reflect a function of how relevant social worker’s felt research evidence was to their daily practice (Murphy & McDonald, 2004).


Attitudes toward EBP Many social workers hold positive views of EBP (Bergmark & Lundstro¨m, 2011; Caldwell, Coleman, Copp, Bell & Ghazi, 2007; Krantz, 2011; Parrish & Rubin, 2011; Pignotti & Thyer, 2009;) and felt it was either important or very important and useful for their work (Edmond, Megivern, Williams, Rochman, & Howard, 2006; Wilson & Douglas, 2007). However, there was a substantial minority who were either unsure about its value (Wilson & Douglas, 2007) or reported negative attitudes (Carrilio, 2008; Murphy & McDonald, 2004), with some social workers forming a “resistance movement” in opposition to it (Bergmark & Lundstro¨m, 2011). The Nature of Evidence and Orientation to EBP For many social workers confusion regarding the nature of EBP was underpinned by confusion over what was meant by the term evidence (Barratt, 2003). Hagell & Spencer (2004) reported that social workers use a wide variety of information sources to inform decision making. In discussion groups with U.K. social workers, the majority of individuals felt that expert opinion was a type of evidence, and was rated as an important influence on practice decisions. Although expert opinion is not a highly rated source in the typical “pyramid of evidence,” there may be a confound in that such experts may be perceived by social workers as being well versed in relevant research, and so their advice may be perceived as a more accessible route to incorporating evidence into daily practice. This may tie into the conceptualization of “knowledge brokers,” which are proving a useful means of increasing and enhancing EBP implementation in other fields (Russell et al., 2010). Professional networks and colleagues were identified as important influencing factors in EBP orientation and implementation in many studies (Bride, Kintzle, Abraham & Roman, 2012; Edmond et al., 2006). Further sources of evidence used by social workers to inform decision making included clinical experience with positive results sustained over time (Parrish & Rubin, 2011), practice experience, intuition, and practice guidelines (Edmond et al., 2006). Evidence typically viewed as the focus of EBP (outcome research) was not seen as being fully aligned to the aims of social work. For example, research exploring the therapeutic alliance was viewed as important by social workers, and the belief that this was excluded by the EBP approach affected participants’ attitudes and behavior toward a policy mandating EBP (Arnd-Caddigan, 2012). Furthermore, although the research reviewed did identify social workers were influenced by outcome research (Krantz, 2011), for many this appeared to be a less frequently consulted source of information (Parrish & Rubin, 2011). Ultimately, practitioners were more likely to use comparative and intuititive approaches to aid practice decisions, rather than an empirical approach to evaluating research (Wharton & Bolland, 2012). A significant barrier to the translation of research into practice was its relevance: for many social workers research was inaccessible, did not reflect the practicalities of daily practice, lacked practice ethics, and did not “flow” well into their daily work. This may be explained by the fact that social workers interpret the utility and validity of research evidence through their own practice wisdom (Wharton & Bolland, 2012). Bergmark and Lundstro¨m (2011) identified four different approaches (value-orientations) toward EBP: evidence skepticism, rule-oriented evidence, research-oriented practice, and activist social work. The evidence-skepticism factor relates to the perspective that social work is a moral


390


practice, or art form, which is in danger of being diluted or corrupted through the rigid application of the scientific method. Bergmark & Lundstro¨m (2011) highlight that many proponents of EBP feel that the strongest reasons for its adoption is that it represents an ethical means of working (i.e., only recommending practices which appear to be sound and effective, based on evidence). However, this factor suggests that social workers who are skeptical of EBP question this assumption. The rule-oriented factor relates to a wish for clearer directives from the outside world, for example guidelines, rules, and policies from regulatory bodies and represents a guidelines perspective of EBP. This factor also represents demands for evaluations using RCTs and rejection of un-evidenced interventions. The research-oriented practice factor may represent the belief that the search for and assessment of research is something which is the responsibility of social workers and is most closely aligned with traditional definitions of EBP. The activist social work factor represents a multi-faceted view of social work and EBP: with concerns of retrenchments, skepticism regarding the control imposed on social work from the outside world (and lack of discretion for professionals in the field) evident. Combined, these factors demonstrate that social workers’ perceptions of the relationship between social work and EBP are complex and there are concerns (as well as positive beliefs) at the philosophical as well as practical implementation level. According to Fielding et al. (2009), social workers should be viewed as active agents in the knowledge generation of their field: leaving traces of the EBP practice where they work. In this way EBP may be viewed as developing, and being developed by, organizational culture and may help to explain why training and socialization are important factors in explaining the variability of viewpoints on EBP (Murphy & McDonald, 2004). Knowledge of EBP A portion of the research reviewed explored social workers self-reported (Pope, Rollins, Chumba & Risler, 2011; Wilson & Douglas, 2007) and objective (Bride et al., 2012; Gosling & Westbrook, 2004; Hagell & Spencer, 2004) knowledge of EBP and related practices. Findings were mixed. Morago (2010) found that 75% of participants reported having good knowledge of EBP. However, in another study with social workers in Northern Ireland, only 35% were satisfied or very satisfied with their knowledge of EBP (Wilson & Douglas, 2007). Of those remaining 38% were unsure of their knowledge and 28% were either dissatisfied or very dissatisfied. These figures may also reflect the level of confidence social workers had of their awareness of EBP and, as exposure to EBP has been found to be crucial to the development of positive attitudes toward EBP (Bride et al., 2012), it is likely to affect implementation. For example, 75% of Australian social workers were aware of an online evidence-system and as a result utilized it. However, another study with American school social workers, found that although 99% of participants were aware of least one evidence-based intervention program, only 72% reported having used at least one such program in the past 3 years. A similar finding was observed by Pope et al. (2011) who found that 83% of their sample of U.K. and U.S. social workers were aware of information databases, but only 56% reported using relevant research within their practice. Findings such as these highlight the research-practice gap in social work. Interestingly, 87% of the social workers in Pope and colleagues (2011) sample still felt that they incorporated clinical judgment and research into their practice, suggesting a further gap between perceptions of EBP use and actual EBP implementation. In a study by Hagell and Spender (2004) a measure of objective, rather than self-reported EBP knowledge, was administered to a sample of U.K. social workers, but was received very poorly and was subsequently dropped from the research. The findings demonstrated great variation in the number of correct responses: from 83% to 44%, suggesting that there may be an underlying misunderstanding of the nature and features of EBP and related behaviors.


391


Practice of EBP Findings from the studies reviewed identified variability in social workers’ adoption and implementation of EBP. Some research identified that participants reported using evidence-based practices (Parrish & Rubin, 2011; Pignotti & Thyer, 2009). However, this was often infrequent and there was limited research utilization, despite positive attitudes toward the principles of EBP (Caldwell et al., 2007). Edmond and colleagues (2006) found that there were specific differences in the implementation of the core steps in EBP. In particular, the majority of the social workers in their sample (U.S. field instructors) frequently used the first EBP step (formulating specific answerable questions), but used the other steps (findings and appraising evidence, applying practice-relevant scientific evidence, and evaluating the utility of information obtained by evaluating treatment outcome/process) less frequently; with only half always or usually using them. In fact, a substantial minority stated that they only sometimes or never used them. In a study with U.K. social workers Morago (2010) found that 83% reported their implementation of EBP has either “very poor” or “modest.” Wilson and Douglas (2007) found that only 28% of their sample reported using EBP in their work often, whereas 45% used it only sometimes, 24% seldom, and 3% (1 person) never used it. The issues concerning self-reported measurements of EBP implementation were illustrated by research conducted by Arnd-Caddigan (2012), when exploring the impact of a policy mandating EBP in U.S. social workers’ practice. Arnd-Caddigan (2012) found that clinicians reported their work was consistent with the policy, however, their actual practice was not actually fully aligned with EBP. For example, rather than searching for and evaluating research evidence for different interventions’ effectiveness impartially, social workers often sought out evidence for pre-held beliefs about interventions. Furthermore, non-conformity with the mandate was demonstrated in two polarized ways: some social workers in this sample opposed EBP and engaged with research infrequently, whereas others felt the EBP policy did not go far enough and went above-andbeyond the requirements of the mandate. A further concern raised by this study was that in order to satisfy the requirements of insurances companies funding their client’s treatments, social workers reported their practices in very different ways to when they reported them for research purposes (i.e., recording their approach as cognitive-behavioral rather than integrative). This reflected the social worker’s perceptions of a climate in which certain language was valued by the insurance companies, rather than any form of deception. However, this may mean that there is a distortion in the perceptions of the adoption and implementation of EBP across the social work population.

Comparisons with Other Professional Groups As is clear from the earlier discussion of EBP’s relevancy to social work, social workers appear to make comparisons between their own field and other professional groups on their adoption and implementation of EBP (e.g., Murphy & McDonald, 2004). Two studies made direct comparisons between social work and other professions; in a comparison between social workers, licensed marriage and family therapists (LMFTs) and psychologists, Parrish and Rubin (2011) found that U.S. social workers actually reported greater experience of EBP courses. They also reported similar levels of self-efficacy, orientation toward and perceived feasibility of EBP processes, and self-reported use of EBP to LMFTs, but lower levels on all these facets compared with psychologists. Social workers were less likely to rely on research evidence and practice guidelines in comparison to psychologists, but were more likely in comparison with LMFTs. However, in a comparison between social workers and healthcare practitioners Murphy and McDonald (2004) rated their knowledge of the evidence available to inform their practice areas as lowest.

392


Barriers to EBP Manuel, Mullen, Fang, Bellamy, & Bledsoe (2009) categorized the barriers that social workers encounter when implementing EBP into three levels: individual, organizational, and systemic. These three categories were evidenced in much of the research reviewed and so offer a useful framework for presenting the findings.


Individual Level Barriers Lack of time (Bellamy, Bledsoe, & Traube, 2006; Cooke, Bacigalupo, Halladay, & Nowood, 2008; Edmond et al., 2006; Morago, 2010; Wilson & Douglas, 2007) was consistently reported as a key barrier to EBP implementation. Other individual level barriers included: lack of training and professional development (Barratt, 2003; Bellamy et al., 2006; Cawood, 2010; Gosling & Westbrook, 2004; Morago, 2010; Manuel et al., 2009; Wilson & Douglas, 2007), lack of expertise, knowledge and skills (Bellamy et al., 2006; Carilio, 2008; Cooke et al., 2008; Edmond et al., 2006; Gosling & Westbrook, 2004; Manuel et al., 2009; Morago, 2010; Wharton & Bolland, 2012; Wilson & Douglas, 2007), suspicion of research, and lack of supervision and monitoring pertaining to research (Manuel et al., 2009). Wharton & Bolland (2012) found that most social workers in their sample had time to access and read literature, but it was time-management which was the issue. Indeed, other social workers suggested that it was managing competing demands which was the issue (Cawood, 2010). Organizational Level Barriers Agency characteristics (Aarons & Palinkas, 2007; Collins-Camargo & Royse, 2010; Cooke et al., 2008; Manuel et al., 2009; Morago, 2010; Wilson & Douglas, 2007), lack of needed information, resources, and funding (Bellamy et al., 2006; Cawood, 2010; Edmond et al., 2006; Manuel et al., 2009; Wharton & Bolland, 2012; Wilson & Douglas, 2007), and lack of organizational support (Cawood, 2010) were identified as organisational barriers to EBP. Within this category, further barriers were noted including: accessibility of research evidence and resources, technology, and organizational culture. Accessibility Social workers identified inconsistent access to the Internet (Wilson & Douglas, 2007) and cost of access to resources (Bellamy, et al., 2006; Wharton & Bolland, 2012) as key barriers to EBP. Indeed, Barratt (2003) found that social workers identified improved Internet access (82%) and access to library sources (80%) as potential promoters of EBP implementation. However, some studies reported good access to such resources such as: the Internet (Edmond et al., 2006; Kreuger, Stretch, & Kelly, 2006; Wharton & Bolland, 2012), research databases and journals (Edmond et al., 2006; Wharton & Bolland, 2012), and practice manuals (Edmond et al., 2006). However, access to dedicated EBP work policies appeared to be more limited (Wharton & Bolland, 2012). In a study exploring U.K. social worker’s level of research activity, use, and skill, Cooke et al. (2008) found that most (69%) had access to the Internet, with 65% of these individuals reporting using it for work information purposes. Although 42% of individuals had access to senior practitioners who provided them with research information, only under half actually consulted them to obtain such information. Despite only 12.8% of individuals having access to them, over 50% of these individuals used literature databases for information. This suggests that although access was limited, these resources may be valued by social work staff. Also noted by the research was that different workplace settings reported different access to the Internet, journal articles, and research summaries (i.e., community vs. hospital vs. central offices).


393


Wilson and Douglas (2007) found that 19 participants had access to the Internet and library, 30 had access to relevant journals/publications, but only 7 had access to forums for the sharing of case material and only one was able to attend multi-disciplinary case discussion. This is interesting because face-to-face discussion appears to be a preferred method of information gathering. Therefore, increasing routes to multi-disciplinary discussion forums may promote greater EBP implementation. For some social workers it was not so much the issue of access, but how to overcome the perceived “overwhelmingness” of the research (Wharton & Bolland, 2012). Other social workers specifically felt that their computer skills held them back from implementing EBP (Edmond et al., 2006). Technology Technology plays an important role in modern EBP, for example computers and the Internet are useful tools for information searching, storage, and dissemination. However, some social workers felt uncomfortable using computers or felt the skills were limited (Carrilio, 2008). Importantly, some social workers felt that the use of technology was changing the face of social work and new technologies may change the delivery of systems in social work from t traditional, narrative-based practice to object-oriented narratives and “fast practice” (Kreuger et al., 2006). Kreuger and colleagues (2006) found that although 74% of their participants felt new technologies had increased control over their work, 20% felt that they had had the opposite effect, and 90% felt that technology had either definitely, or may have reduced their personal discretion. Ultimately, the authors suggested that new technology may result in greater isolation of social workers and reduction in face-to-face communication between students, educators, colleagues, and clients. However, it is not clear whether similar findings would be identified today with, for example, the growing uptake of social media (Kaplan & Haenlein, 2010). Organizational Culture Specifically in relation to agency characteristics and organizational culture, lack of organizational focus on, or priority given to EBP (Wilson & Douglas, 2007), the presence of a blaming culture is identified as leading to over-reliance on previous methods (Barratt, 2003). Specific to school social work practitioners, the strong emphasis on academic performance (rather than school violence prevention) was identified to be a key implementation barrier (Cawood, 2010). Despite organizational culture being identified as a potential barrier to EBP, many social workers (ranging from 31% –70% of individuals across the samples) felt supported in the implementation of EBP in their role (Edmond et al., 2006; Wilson & Douglas, 2007). However, there were an important minority who either were unsure whether they felt supported, or did not feel supported (Beddoe, 2011; Edmond et al., 2006; Wilson & Douglas, 2007). Further research is required to understand these individual’s experiences and identify why they felt less supported than some of their colleagues. A characteristic which relates to both organizational characteristics and access is the rurality of services. Murphy and McDonald (2004) found that rural Australian practitioners identified decreased professional development (owing to access to both IT infrastructures and training) owing to the remoteness of the locations in which they practiced. This lead to a diminishing of research evidence implementation as rurality increased. Systemic Barriers Manuel et al. (2009) identified two major systemic barriers to EBP: lack of fit and applicability of research findings to specific practice contexts. A related issue, identified by Arnd-Caddigan & Pozzuto (2010), was that some social workers felt they needed to describe assessments and

394


treatments in a language and terminology that insurance companies, for example, would accept and understand. This may not be concordant with terminology used in research literature, perhaps making its implementation in practice more difficult.


Facilitators Among the facilitators suggested by social workers and authors were: perceived support (Gosling & Westbrook, 2004), protected time, workload easement and increased staffing (Booth et al., 2003; Cawood, 2010; Wilson & Douglas, 2007), targeted skills training (Cawood, 2010; Gosling & Westbrook, 2004; Manuel et al., 2009), promoting a team approach to EBP (Manuel et al., 2009), providing mentorships and apprenticeships (Cooke et al., 2008), greater partnerships between social work organizations and universities (Manuel et al., 2009), developing forums for discussion of EBP (Wilson & Douglas, 2007), enabling greater access to resources and information (Gosling & Westbrooke, 2004) and providing “reflective spaces” to allow social workers to reflect on their practice (Fielding et al., 2009). Transformational leadership was associated with higher innovation climate and more positive attitudes toward EBP implementation (Aarons & Sommerfeld, 2012). Furthermore, social workers receiving effective supervision were more likely to view their organizational culture as promoting EBP, and in turn were more likely to rate their self-efficacy as higher (Collins-Camargo & Royse, 2010). Experience of Research in Practice Only a few of the studies reviewed discussed social worker’s experiences of being involved in research. One such study by Cooke et al. (2008) identified small numbers of respondents who had completed an Master’s degree (11%), collaborated in a research project (12%), were currently involved in research (12%), or were planning to conduct research in the next year (11%). However, the majority of participants (69%) felt that research would help them in their practice, and 68% suggested they would like to conduct their own research (with experienced collaborators). This is consistent with Wilson and Douglas’ (2007) finding that following a workshop, social workers highlighted a range of topics which would be benefited from being researched by them. Encouraging practitioner-led research may be a means of increasing engagement with research and promoting the benefits of research to practice, as well as helping to ensure that research findings are discussed in the terminology and context which makes them relevant to those whom they are aimed at. That is, it may provide a mechanism of producing and increasing an evidence-base of practical research findings. Education and Training Despite the importance of education, access to training appeared to be problematic for social workers: in one sample 62% of social workers had never attended EBP training (Morago, 2010), in another study, only 44% had received training in using research findings and only 42% had received training in Internet use (Booth et al., 2003). One other study identified that some social workers felt EBP had been missing from their initial training and from on-going professional development (Murphy & McDonald, 2004) and relied on workshops and conferences to strengthen their knowledge and skills (Edmond et al., 2006). This is a concerning trend. Importantly, Parrish and Rubin (2011) did not find any significant differences between recent and earlier social work graduates on their level of self-efficacy, perceived feasibility, or implementation of EBP. A number of training events and methods were discussed in the literature. Wilson and Douglas (2007) piloted a workshop designed to disseminate local examples of EBP produced by staff working within the Southern Health and Social Services Board in Northern Ireland. The workshop



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received positive feedback and appeared to be valued by the attendees and also involved a session aimed at helping attendees to identify topics which they could research themselves. Manuel and colleagues (2009) explored social workers’ views on EBP following an intervention, Bringing Evidence for Social work Training (BEST), which involved training and technical assistance from university researchers and three social work agencies in the United States. The intervention was useful in highlighting the benefits of collaborative working with universities, identifying barriers and promoters of EBP, and helping practitioners to learn about the EBP steps and develop positive attitudes toward EBP. Parrish and Rubin (2011) found that in a one-day continuing education training event on community social workers’ EBP, participants’ self-reported ratings on a range of measures (including EBP self-efficacy, attitudes, perceived feasibility, intentions, and knowledge) all showed significant improvements, even when measured at a 3-month follow up. This suggests even a oneday training event can have profound and positive effects on the understanding, orientation to, and application of EBP. Hagell & Spencer (2004) piloted the use of audiotapes to disseminate up-to-date research evidence, with positive and negative effects. Social workers’ were able to use “dead time,” such as driving, to listen to research evidence and therefore fit it into busy work schedules. However, some researchers found that some information was difficult to remember in this format because they couldn’t take notes. Participants reported that they found the more conversational style tapes more engaging than the academic-style tapes, which corresponds to a general preference identified across the literature for engaging with research in this way. The authors suggest that this method of dissemination may be better suited to some forms of information rather than all. The findings from these evaluation studies provide insights into effective methods of enhancing research evidence in practice. However, many of them relied on small samples and, apart from Parrish and Rubin’s (2011) study, measured EBP implementation directly after the event. It is therefore unclear whether all the changes measured following the training events had longevity.

DISCUSSION Limitations of the Review No articles written in languages other than English were included: in an attempt to increase the comparability of research findings only articles from Western cultures were included (i.e., United Kingdom, European, Northern American, and Australian). However, each country (and state/region within that) will be associated with its own practices, qualification routes, and job roles meaning that findings should be interpreted tentatively. No unpublished research was included in the review, potentially introducing publication bias. However, this does mean that all articles included in the review have been through the rigor of the peer-review process. Narrative synthesis may be at greater risk of confirmation bias than quantitative synthesis, however, the PRISMA guidelines were adopted to mitigate this issue. Finally, there are a plethora of job titles used in the literature to refer to social workers, which are often under-defined and can be misleading and difficult to interpret. Strengths and Limitations of the Research Reviewed The literature base exploring social workers’ perceptions of, attitudes toward, practice of, and knowledge and skills in EBP is growing, but is still narrow. This, and the fact that the methods employed in research are varied, means that it is not yet large enough for a meta-analysis.


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Quality assessment of the studies revealed studies ranged from weak to strong, with the modal award being weak. A number of methodological issues may explain these findings; a large proportion of the studies reviewed used convenience or purposive sampling, bringing into question the representativeness of some of the research findings. Also, some of the studies’ samples were reported as small and female dominated, with low response rates. Although this may reflect the demographics of the population and the issues with recruiting busy practitioners, further research is required to explore these issues and generalizations of these findings should be tentative at this stage. Furthermore, many of the quantitative research studies relied upon self-report measures of attitudes, knowledge, and implementation. Although this may be the most convenient method of collecting data with busy participants, it may introduce bias from inaccurate recollection, socially desirable responding, and it typically measures frequency of adoption, rather than quality of implementation: little attempt was made in the studies to control for these issues. Implications of the Review The review highlights that there is a great deal of confusion regarding what EBP as an approach actually represents. For EBP to progress in the field, further work must be carried out to explore what EBP means for social workers. This may help to explain contradictions in the literature and may allow for potential misunderstandings of the EBP process to be explored. With this, further work could be conducted to develop a definition of EBP which would provide the most applicable and best means of providing a beneficial framework for social worker’s practice decisions, while retaining the field’s professional identify. The review identified that the orientations and practices of colleagues, peers, and perceived experts in the field are important for the dissemination of evidence, and that social workers may prefer more conversational, face-to-face methods of dissemination than academic, computer-based approaches. This information could be used to inform EBP interventions, through increased access to EBP forums, professional development events, and utilization of “knowledge broker” models. Combined, these may also provide a mechanism for increasing time-management as they could be incorporated into a role as dedicated (or where possible, protected) time and may thereby reduce time and resource demands, which are consistently identified as barriers. Furthermore, training should take into account the unique barriers of the context in which social workers work (e.g., rural vs. urban, community vs. hospital vs. school) as an assessment of organisation culture will help to ensure that targeted workshops can be offered in those areas where support is most needed (and therefore has greatest impact and effectiveness). Although portions of the social worker samples in the reviewed articles noted that they had good access to resources, this is far from consistent and two major concerns raised were the cost of access, and the accessibility and applicability of research findings themselves. Increase publications in open access journals and professional magazines may also provide a way of disseminating evidence and best practice in accessible and cost effective ways. A further means of raising the profile of research, and enhancing the applicability of research findings, may be to provide social workers with greater opportunity to become involved in research and lead their own research projects. Only small numbers of social workers reported that this was the case, despite a positive attitude and interest in this being evidenced in the research.

CONCLUSION The factors identified as important to EBP implementation provide a starting point to review training, policy, and practice. However, they are complex and therefore any approach which aims to reduce the research-practice gap may need to be equally multi-faceted.



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Although some social workers were unsure about the value of EBP, or felt it was not appropriate for social work, a substantial proportion of social workers held positive attitudes toward EBP in their practice and felt it could enhance social work as a profession, and the delivery of services that social workers support. Further work is required to explore whether negative views of EBP arise from misunderstandings or miscommunications about the nature of EBP (i.e., the role that scientific evidence should play in decision making, and what forms of evidence, such as outcome or process, quantitative or qualitative, should be used) or whether EBP should be adapted to take into the philosophical underpinnings of social work more clearly. Ultimately, it may come down to whether social work should be viewed as evidence-based (emphasis on research evidence in decision making), or evidence-informed (research evidence as one piece of the puzzle). Communicating this may help to develop a common EBP definition and language which will allow social workers to communicate and appraise research findings and best practice in ways that have the most utility and impact for other professionals in the field. Ultimately, to understand the future of EBP in the social work profession this review suggests that further work is required to explore the views, attitudes, and practice of those individuals involved in its implementation. Only this way may the research-practice gap be better understood and reduced.

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